Academic journal article Journal of Marital and Family Therapy

Children and Psychotropic Medication: A Cautionary Note

Academic journal article Journal of Marital and Family Therapy

Children and Psychotropic Medication: A Cautionary Note

Article excerpt

This report addresses how the mental health field is organized in terms of the use of psychotropic medications with children and adolescents, and the ethical challenge this presents to marriage and family therapists.

This article calls attention to the way the mental health care system is organized to support the use of psychotropic medications as the first line of mental health treatment. The evidence for the safety and efficacy of these drugs in the short term is tenuous at best. There is stronger evidence that their long-term use causes more harm than benefit. For example, although these drugs are held up as miraculous by the pharmaceutical industry and organized psychiatry, since the introduction of modern psychiatric drugs in 1954, there has been a significant increase in the number of people labeled chronically mentally ill in America. There has also been a concomitant rise in the number of permanently disabled American children during this period (Weiss, 2008; Whitaker, 2005, personal communication, February 3, 2008). An exponential increase in the use of these drugs with children has occurred since 1990, despite a complete lack of evidence-based studies supporting their safety and efficacy with this population. Given this fact, the mental health care system appears to have become a process for transmitting individual clinical harm to large groups of people. This is not accidental. Rather, it reflects the organization of the larger medical system, institutions like the Food and Drug Administration (FDA), and American society itself.

In 1976, Ivan Illich opened his classic work Medical Nemesis: The Expropriation of Health, with the assertion, "The medical establishment has become a major threat to health." Illich's assertion that the medical establishment has become a "radical monopoly" that paradoxically generates harm rather than health was verified in 2004 by Null, Dean, Feldman, Rasio, and Smith. This research, entitled "Death by Medicine," showed that in 2001 the total number of deaths caused by conventional medicine was 783,936 per year, while the number of deaths from heart disease was 699,697 and cancer was 553,251. The American medical system is the leading cause of death and injury in the United States.

John Abramson (2004) is among the chorus of voices warning of the iatrogenic dangers in the health care system. American medicine is the most expensive health care system on the planet, yet it ranks 23rd among industrialized nations in creating "healthy life expectancy." The goal of the medical-pharmaceutical complex has changed from creating health to creating wealth. Furthermore, Abramson asserts that what is wrong in American medicine is also wrong in psychiatry, the medical subspecialty that now dominates mental care in America.

David Healy (2002), the British psychiatrist and researcher who blew the whistle on the dangers of SSRI antidepressants for children, concurs with Abramson. He wonders aloud what these giant pharmaceutical companies, "which barely existed before WWII," are doing to us. He answers his own rhetorical question with the assertion that they have shifted from "discovering treatments for major diseases to medicalizing aspects of the human condition." He asserts these companies have "an almost Orwellian capacity to control the flow of information ... as part of a market-development package . . . [that] has the power to rewrite psychiatric textbooks . . . and blind clinicians to the preventable deaths and obscure the fact that the life expectancies of their patients are falling rather than rising" (pp. 2-6).

The pharmaceutical industry has a fiduciary responsibility to its shareholders. Shannon Brownlee (2007) summarizes what this means for the public good. The pharmaceutical industry, she says, has "been doing exactly what it is supposed to do, which is come up with new drugs [that] make money for stockholders." But they can get away with this because "the harm can only be seen in the aggregate, while the responsibility for it is diffuse. …

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